Background: Barium meal is a safe, non invasive, inexpensive and cost effective imaging technique. Most of the malignant gastric masses do present with non specific symptoms such as epigastric pain, dyspepsia, bloating, nausea, vomiting etc. It is imperative to be well acquainted of imaging features of malignant gastric masses on barium studies.

Aim: Review the barium findings of various histopathologically proven malignant lesions of stomach and recognize the pattern of involvement.  

Material and Methods: The barium study films along with clinical and histopathological records were cumulated from the archives of radiology unit of the department of gastroenterology, PGIMER, Chandigarh between the period January 2009 to December 2014. 144 cases of gastric tumours were found, of which complete histopathological diagnosis was available in 69 cases, which were included in this study. Both double contrast and single contrast barium were included in this study. The radiographic findings were reviewed by two experienced gastrointestinal radiologists simultaneously to determine the morphology and location of these neoplasms.

Results: Among 69 cases, carcinoma constituted the majority with 51 cases (73.9%) followed by malignant GIST in 10 cases(14.5%),8 cases(11.5%)  were of NHL. Of the various findings, stricture and malignant ulcer were the most commonly obtained findings on barium study in carcinoma. Nodular fold thickening in lymphoma and large intra luminal polypoidal mass was common in cases of malignant GIST. 

Conclusion: Barium studies, particularly double contrast barium studies are accurate technique in diagnosing gastric carcinoma, with higher sensitivity and sensitivity. We further emphasize that barium study complement endoscopy in gastric malignancies ( by giving an idea to the endoscopist about the nature of the lesion) and should regain its position as one of the main diagnostic tools.